title: Single versus double stapling anastomotic technique in rectal cancer surgery.
abstract: OBJECTIVE
  The present study was designed to investigate whether there is a difference in the anastomotic leakage rate (AL) between the single stapling (CSA) and double stapling (DSA) anastomosis techniques.
  
  
  METHODS
  One hundred consecutive rectal cancer patients who underwent rectal resection with primary anastomosis were enrolled in this study.
  
  
  RESULTS
  The overall rate of clinical anastomotic leakage in both groups was 7 % (7/100); 6 % (3/50) in the CSA group and 8 % (4/50) in the DSA group. The anastomotic technique did not have any significant influence on the rate of AL. All AL were seen in low anastomoses (7 cm and below). The rate of AL in patients with a diverting stoma (13 %, 3/23) was not significantly different from that of the patients without (5.2 %, 4/77) (p = 0.195). The mean length of the operation was significantly shorter in the DSA group compared to the CSA group, at 127 and 141 min, respectively (p = 0.005). There were significantly higher rates of AL in patients receiving preoperative long course radiotherapy (15.4 %, 6/39) compared with those who did not receive radiotherapy (1.63 %, 1/61) (p = 0.014).
  
  
  CONCLUSIONS
  The CSA and DSA techniques are equally safe for the creation of a rectal anastomosis, without any significant difference in the AL rate. However, we recommend using the DSA technique because it has other definite advantages. In cases of neoadjuvant treatment and a low anastomosis, proximal diversion is recommended.
authors.affiliation: Department of Surgical Oncology, Oncology Institute of Vojvodina, Put dr Goldmana 4, 21204, Sremska Kamenica, Serbia, radovanovic.zoran@onk.ns.ac.rs.
authors.forename: Z
authors.initials: Z
authors.lastname: Radovanovic
authors.forename: T
authors.initials: T
authors.lastname: Petrovic
authors.forename: D
authors.initials: D
authors.lastname: Radovanovic
authors.forename: M
authors.initials: M
authors.lastname: Breberina
authors.forename: A
authors.initials: A
authors.lastname: Golubovic
authors.forename: D
authors.initials: D
authors.lastname: Lukic
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000379:methods* / Q000706:statistics & numerical data; D057868:Anastomotic Leak / Q000453:epidemiology*; D059186:Chemoradiotherapy, Adjuvant / Q000009:adverse effects / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011300:Preoperative Care; D012004:Rectal Neoplasms / Q000601:surgery*; D017792:Surgical Stapling / Q000379:methods* / Q000706:statistics & numerical data